<?php

$editor    =& JFactory::getEditor();

?>

<table>

    <tr>

        <td>Nome:</td><td><input size="100" type="text" name="name" value=""></td>

    </tr>

    <tr>

        <td>Cognome:</td><td><input size="100" type="text" name="surname" value=""></td>

    </tr>

    <tr>

        <td>Email:</td><td><input size="100" type="text" name="email" value=""></td>

    </tr>

    <tr>

        <td>Telefono:</td><td><input size="100" type="text" name="phone" value=""></td>

    </tr>

    <tr>

        <td>Scuola/Facoltà:</td><td><input size="100" type="text" name="school" value=""></td>

    </tr>

    <tr>

        <td>Classe/Anno:</td><td><input size="100" type="text" name="classroom" value=""></td>

    </tr>

    <tr>

        <td>Indirizzo Segnalazione:</td><td><input size="100" type="text" name="report_address" value=""></td>

    </tr>
    
    <tr>

        <td>N. Civico Segnalazione:</td><td><input size="10" type="text" name="report_number" value=""></td>

    </tr>

    <tr>

        <td>Cap Segnalazione:</td><td><input size="100" type="text" name="report_zip" value=""></td>

    </tr>

    <tr>

        <td>Descrizione Segnalazione:</td><td><?php echo $editor->display( 'report',  '' , '100%', '350', '75', '20', false ) ; ?></td>

    </tr>

    <tr>

        <td>Foto Segnalazione:</td><td><input type="text" name="report_photo" value="">
        <img src="" id="report_photo" width="100" height="100"/></td>

    </tr>
    
    <tr>

        <td>tipologia:</td><td>

        <select id="report_type" name="report_type">
	        <option value="1">segnalazioni per problemi legati ai semafori</option>
	        <option value="2">segnalazioni per problemi legati alla segnaletica</option>
	        <option value="3">segnalazioni per problemi legati al manto stradale</option>
        </select>

        </td>

    </tr>
    
    <tr>

        <td>risolto:</td><td>

        <select name="report_status" onchange="if(this.value == '1') { $('report_recovery_date').setProperty('value', '<?php echo ( $row -> report_recovery_date && $row -> report_recovery_date != '0000-00-00' ? date("Y-m-d", strtotime($row -> report_recovery_date)) : date("Y-m-d")) ?>')} else { $('report_recovery_date').setProperty('value', '')}">

        <option value="0">No</option>

        <option value="1">Sì</option>

        <option value="2">Preso in consegna (Napolipark)</option>

        <option value="3">Non risolvibile (Napolipark)</option>

        </select>

        </td>

    </tr>
    <tr>

        <td>ritolto il (aaaa-mm-gg):</td>
        <td>
		<input type="text" name="report_recovery_date" id="report_recovery_date" value="">
        </td>

    </tr>

    <tr>

        <td>Note Segnalazione:</td>
        <td>
        	<textarea rows="10" cols="100" id="report_note" name="report_note" ></textarea>
		</td>

    </tr>
    <tr>

        <td>confermato:</td><td>

        <select name="confirmed">

        <option value="0">No</option>

        <option value="1">Sì</option>

        </select>

        </td>

    </tr>
    
    <tr>

        <td>pubblicato:</td><td>

        <select name="published">

        <option value="0">No</option>

        <option value="1">Sì</option>

        </select>

        </td>

    </tr>

</table>

<input type="hidden" name="id" value="">